A Longitudinal, Population-Based Study of the Difficult Journey to Diagnosis Endured by Patients with Eosinophilic Gastritis and Eosinophilic Gastroenteritis

Abstract

To better understand the real-world diagnostic journey of patients with eosinophilic gastritis and/or eosinophilic gastroenteritis (EG/EGE). This study focused on 4,097 EG/EGE patients (2,531 adults, 468 adolescents, 1,098 children) meeting all eligibility criteria from a representative (∼300 million US individuals) administrative claims database from 2008-2018. Patient medical and pharmacy claims history was analyzed to describe the events related to presentation and diagnosis of EG/EGE. Median (IQR) years from initial symptom presentation to diagnosis was 3.4 (1.5–5.6) and was significantly longer for adults (4.0, 1.9–6.1) vs adolescents (2.6, 1.0–4.3, p<0.001) or children (2.7, 1.0–4.6; p<0.001). Between initial symptom presentation to EG/EGE diagnosis, patients visited 4.8 ±0.1 healthcare providers and 59% received alternative diagnoses of nonspecific gastrointestinal conditions. Adults demonstrated a significantly longer time to gastroenterologist referral and endoscopy vs adolescents or children (p<0.001). Almost half (46%) of all patients required >1 endoscopy to diagnose EG/EGE and experienced significantly longer diagnostic delay vs those requiring single endoscopy (4.3 vs 2.5 years, p<0.001). Failure to diagnose on first endoscopy was due in part to absence of histopathology evaluation, which was performed less frequently in adults (64%) vs adolescents or children (88% and 89%, p<0.001). EG/EGE patients, especially adults, endure a lengthy and difficult path to diagnosis. Factors contributing to delayed or missed diagnoses include delayed endoscopy and failure to biopsy or perform histopathology evaluation on initial endoscopy. Heightened HCP disease awareness should lead to earlier endoscopic and histopathologic evaluation, improving the patient’s journey to to diagnosis and enabling earlier therapeutic intervention.